不同麻醉药物配伍对行腹腔镜下肿瘤切除手术的老年患者血流动力学及术后认知功能的影响

Effects of Different Anesthetic Drugs on Hemodynamics and Postoperative Cognitive Function in Elderly Patients Treated with Laparoscopic Tumor Resection

目的分析不同麻醉药物配伍对行腹腔镜下肿瘤切除手术的老年患者血流动力学及术后认知功能的影响。方法选取78例行腹腔镜下肿瘤切除术的老年患者为研究对象,随机将患者分为实验组和对照组,每组各39例,分别于手术治疗前给予2组患者不同麻醉药物配伍进行麻醉。实验组患者接受七氟醚、瑞芬太尼联合右美托咪定3种麻醉药物配伍麻醉,对照组患者接受异氟醚、芬太尼联合咪唑安定3种麻醉药物配伍麻醉,监测2组患者的血流动力学指标变化,比较2组患者术后认知功能评分。结果实验组患者在麻醉诱导后、插管时及拔管后的血压、心率、左室射血分数及左室短轴缩短率等血流动力学指标优于对照组,且2组在麻醉诱导后、插管时及拔管后的血压及左室射血分数组间比较差异有统计学意义,在麻醉诱导后的心率及左室短轴缩短率组间比较差异有统计学意义(P<0.05)。实验组患者术后定向力恢复时间、自主呼吸恢复时间及术后简易精神量表评分均优于对照组,且差异有统计学意义(P<0.05)。结论七氟醚、瑞芬太尼联合右美托咪定麻醉药物配伍及异氟醚、芬太尼联合咪唑安定麻醉药物配伍均有利于稳定老年患者腹腔镜下恶性肿瘤切除术前麻醉诱导期的血流动力学指标,但七氟醚、瑞芬太尼联合右美托咪定麻醉药物配伍的临床效果更好,更利于患者术后认知功能的恢复,临床安全性较好。

Objective To analyze the effects of different anesthetic drugs on hemodynamics and postoperative cognitive function in elderly patients treated with laparoscopic tumor resection .Methods 78 elderly patients with laparoscopic tumor re-section were randomly divided into the experimental group and the control group ,39 cases in each.Respectively,before surgery the 2 groups were given different anesthetics for general anesthesia .The experimental group received sevoflurane and remifentanil combined with dexmedetomidine 3 sedations anesthesia ,the control group received isoflurane anesthesia ,fentanyl combined with midazolam 3 anesthetics combined ,hemodynamic indexes in patients with 2 groups of monitoring ,cognitive function score the 2 groups were compared after treatment .Results The experimental group after anesthesia induction ,intubation and extubation after the blood pressure,heart rate,left ventricular ejection fraction and left ventricular fractional shortening hemodynamic indexes than the control group ,and two in the group after anesthesia induction ,intubation and extubation after the blood pressure and left ven-tricular ejection fraction between the 2 groups there was a statistically significant difference , after induction of anesthesia in the heart rate and left ventricular fractional shortening ,there were statistically significant difference （ P〈0.05）. The experimental group after orientation of mini mental scale recovery time ,breathing recovery time and postoperative scores were better than the control group,and the difference was statistically significant （ P〈0.05）.Conclusion Sevoflurane and remifentanil combined with dexmedetomidine anesthesia drugs and isoflurane and fentanyl combined with midazolam sedations were conducive to the sta -bility of elderly patients with laparoscopic resection of malignant tumor before anesthesia induction period hemodynamics ,better clinical effect of remifentanil combined with sevoflurane ,but,dexmedetomidine sedations are more conducive to patients recovery of cognitive function ,with good clinical safety .